抗CCP抗体与类风湿关节炎肺间质性病变相关性的临床研究.docVIP

抗CCP抗体与类风湿关节炎肺间质性病变相关性的临床研究 　　【摘 要】 目的：探讨抗环瓜氨酸肽（抗CCP）抗体与类风湿关节炎患者合并肺间质性病变的相关性。方法：选取75例RA患者，所有患者均行胸部HRCT检查，对肺间质性病变进行半定量评分；采用酶联免疫吸附法测定抗CCP抗体（阴性参考区间为0～5 RU?mL-1），按照其定性结果进行分组。观察抗CCP抗体阴性组及阳性组间肺间质性病变的评分有无差异。结果：抗CCP抗体阳性组与阴性组比较，各影像学表现出现的频次差异无统计学意义（P 0.05）；但抗CCP抗体与弥漫性肺间质性病变间有相关趋势（P = 0.061）。抗CCP抗体阳性组肺间质性病变的半定量评分高于阴性组（平均秩序为40.43和28.30，P 0.05）。结论：抗CCP抗体与类风湿关节炎肺间质性病变相关，抗体阳性者病变较阴性者重。 　　【关键词】 关节炎，类风湿；抗CCP抗体；肺间质性病变；HRCT；半定量评分 　　doi：10.3969/j.issn.2095-4174.2015.08.003 　　【ABSTRACT】Objective：To investigate the correlation between anti CCP antibody and rheumatoid arthritis with interstitial lung disease.Methods：75 patients with rheumatoid arthritis were underwent chest HRCT to get semiquantitative scores.Enzyme-linked immunosorbent assay（ELISA）was used to determine the CCP antibody （The negative reference interval is 0～5 RU?mL-1） and the patients were grouped according to the results.The differences of scores of interstitial lung disease between the negative and positive groups were observed.Results：There was no significant difference in the frequency of CCP（P 0.05），but the anti CCP antibody had a correlation with diffuse interstitial lung disease（P = 0.061）.The semi quantitative score of CCP in the positive group was higher than that in the negative group（the average order was 40.43 and 28.30，P 0.05）.Conclusion：There is a correlation between anti CCP antibody and rheumatoid arthritis with interstitial lung disease，and pathological changes in positive patients are more serious than those in negative ones. 　　【Keywords】arthritis，rheumatoid；anti CCP antibodies；interstitial lung disease；HRCT；semi quantitative score 　　类风湿关节炎（rheumatoid arthritis，RA）是一种以关节慢性炎症为主的自身免疫性疾病，如不早期诊治，可导致关节不可逆的破坏，最终造成关节畸形，严重影响患者生活质量。此外，RA尚可继发诸多关节外表现，如血管炎、肺间质性病变（interstitial lung disease，ILD）等。ILD是RA最为常见，且为主要致死原因的关节外表现。结缔组织病所致ILD的病理分型、临床症状及影像学表现与特发性ILD一致，临床上主要表现为渐进性劳力性气促，弥散及通气功能障碍，低氧血症，最终发展为呼吸衰竭而致死亡。影像学上，早期HRCT检查可见局限性结节、索条影；或表现为弥漫性磨玻璃影，随病情进展可发展为网格及蜂窝状改变。抗CCP抗体是RA的特异性自身抗体，被广泛应用于RA的诊断，并被认为与骨质破坏有关。但该抗体与RA